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Stress and psychiatric disorder in urban Rawalpindi

Community survey

Division of Psychiatry, University of Bristol, Bristol, UK

FAREED ASLAM MINHAS, MRCPsych, IMTIAZ AKHTAR, MBBS, SAEED AKHTER, MBBS and MALIK HUSSAIN MUBBASHAR, FRCPsych

Institute of Psychiatry, Rawalpindi Medical College, Pakistan

Correspondence: David B. Mumford, Division of Psychiatry, University of Bristol, 41 St Michael's Hill, Bristol BS2 8DZ, UK. Tel: 0117 928 7773; fax: 0117 925 9709

Declaration of interest None.

Background Recent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women.

Aims To investigate emotional distress and common mental disorders in a poor urban district using the same survey method.

Method First-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD—10 research diagnostic criteria.

Results On a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women.

Conclusions This study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.

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